I Am Medically Uninsurable ... Because of a Sprained Ankle

Syndicated

I am medically uninsurable.

I know this because two different companies -- CareFirst and Aetna -- have declared it so in the past two weeks.

Let me tell you what medically uninsurable looks like.

I am 39 year old mother of two.  I am overweight, but not obese.  I am an Irish Dance teacher.  I am a student of Muay Thai kickboxing. I exercise at least 5 times a week. I can do 75 push-ups.  I can do 200 sit-ups in a row without a break.  I can knock over a heavy bag with a push kick.  I eat a lot of fruits, vegetables, protein and fiber.  I have a weakness for Starbucks Chai and pasta.  I am on low dose medication for hypertension.  I haven't been sick with anything other than colds for several years.  Last fall, I herniated two discs in my neck, but after physical therapy and acupuncture, my neck is now fine.  I have no symptoms.  I can kickbox and dance.  In August, I sprained my ankle on an elliptical when I was on vacation at the beach. I went to the doctor twice.  He advised I wear the AirCast I already owned, rest it, ice it, and take Motrin.  I went back a few weeks later and got a cortisone shot.  Now my ankle is fine.

I am medically uninsurable because I went to the doctor for my sprained ankle, Aetna tells me.  "But the ankle is fine now," I say.  "I danced four Irish dance shows in one weekend on this ankle. I can send you the video."  "You went to the doctor," Aetna tells me.  It doesn't matter to them that the injury is healed.  What matters to them is that I went to the doctor in the month before I applied for health insurance.  "I can go back to the doctor and have him certify that it is fine. He can write it in the records." "Don't do that," Aetna tells me, "because then you've gone to the doctor again.  That counts as treatment."

Don't go to the doctor if you want health insurance.  Don't even go the doctor to have him certify that you are healthy if you want health insurance.

CareFirst won't insure me either because of the disc injury last year and, yes,  the completely healed ankle sprain.

That was the most ill-advised 30 minutes I have ever spent on an elliptical.

If my husband and I were part of a group, none of this would be an issue, but we're not part of a group because our employers won't provide benefits.  We're in this impossible situation of trying to find individual health insurance for our family because my husband's employer refuses to provide health care benefits.  We're in this impossible situation of trying to find individual health insurance for our family because my employer, a community college, won't provide health care benefits to part-time faculty.

Who says the system isn't broken?

In the spring of 2009, my husband's full-time job (with great benefits) was cut from 5 days a week to 3 days a week, and his pay was cut almost in half.  The majority of his department was laid off.  There was no advance notice of this downsizing. My husband is pretty much our sole support.  I work part-time teaching college English, but it's hardly a living. Losing half of my husband's salary meant we were in very real danger of losing everything, including our house.  

In less than 2 months, he found a new job -- his current job. It looked like a lucky break. They matched his full-time salary.  It was close to home.  We wouldn't have to move in with my mother and default on our mortgage, but there was one problem.  The new company didn't have a health insurance plan.  We hesitated; we couldn't possibly have our main breadwinner in a job that didn't have health benefits. "We don't have benefits yet, but we're working on it," the company told my husband, so we took the job because we were in that desperate of a situation.  We chose to believe they would offer benefits because they said they would. We really didn't have another choice.

Our COBRA premium from the downsized job was $1800/month, but we qualified for Obama's Cobra Subsidy plan (thank you, Obama) which brought our COBRA payments down to $690/month.   We were just able to pay those.  Just.

And we waited for health insurance benefits from my husband's company that never came.  Why?  We have no idea.  Things just went from working on providing benefits to not providing benefits at all.  Now we are stuck.

Our Cobra subsidy runs out in 3 days.  On October 1st, our premium payments go up to $1911.25 a month.  We only have two months left on COBRA.  On December 5th we have no insurance at all, but that date may as well be October 1st.  Do you have $1911.15 to pay for one month of insurance premiums?  Do you have $3822.30 to pay for two months of insurance premiums?  Can I borrow it from you because I checked our couch cushions and under the floor mat of the car and we're a little short?

We have to find individual health insurance, and I've been working on it all month.  My brain has been crowded with pre-existing conditions, premiums, HSAs, state funded high risk pools, and co-pays.

The first plan we applied for turned my husband down because he has ADHD.  I was denied because of my neck injury last year and my completely healed sprained ankle.  They accepted our two children because the Health Care Reform law that went into effect on September 21st bars health insurance companies from denying coverage to children due to pre-existing conditions.  Thank God for that law or I would not be able to get health insurance for my son, Ace, who has ADHD and Sensory Integration Dysfunction. To an insurance company, Ace is a walking pre-existing condition with a faux hawk and a killer smile.

The second plan approved my husband with a 25% rate increase because of his ADHD and no coverage of pre-existing conditions for 12 months.  They approved my children, but we have to pay an extra $50 a month for Ace because of his ADHD.  They declared me medically uninsurable.  That 5 mg pill I take for hypertension was the problem this time. Oh, and the completely healed sprained ankle.

(In case you're curious, this is not a cadillac policy.  It's a pretty bad policy actually.  It has a $6000 annual deductible.  We pay everything including well-visits and all prescriptions until we hit $6000.  Then the insurance kicks in their share.  Oh, and the monthly premium is $470 a month for this policy for my husband and two children.)

In 2014, none of this stuff will matter. My ankle sprain won't matter because insurance companies won't be able to deny anyone insurance due to pre-exisiting conditions.  (Thank you, Obama.)   That is 4 years away though because why?  Oh, right.  Republicans and the health insurance industry held it back.  Also, if the Republicans win control in the next election, health insurance reform may be repealed.  I keep forgetting the system isn't broken.

"Well," I thought.  "At least, we can get insurance through the state."  You know, those high risk pools for people who have been declined coverage due to pre-exisiting conditions?

No, we can't.

We can't get insurance from the state because we are still eligible for COBRA.  It doesn't matter that the cost of the COBRA for two months is so high as to be laughable. ($3822.30!)  It doesn't matter that we can't possibly afford to pay it.  We could (if we lived in fantasy land) pay it, so we have options, according to the state.  We either have to pay for the COBRA for two months and then apply for the state plan, or we can be uninsured for two months and then apply for the state plan.  $3822.30 or uninsured for 60 days and then we're declared desperate enough by the state.

I have to question people who don't think our health insurance system is broken.  All I can assume is that you are lucky enough to have an ironclad job with an employer who provides good benefits.  I hope you are never downsized or laid off.  I hope you never have to look for insurance for your family on your own because the truth is that if your employer doesn't provide health care benefits in our current health care system, you are well and truly screwed.

And let me ask you this . . .

If I'm medically uninsurable, how do you think you'll do?

(Here is the video I offered to send Aetna.  I believe I will entitle it the "Dance of the Medically Uninsurable."  Well, the other dancers all have insurance as far as I know, so we'll call it the "Dance of the One Medically Uninsurable Person Dancing on A Obviously Crippling Injury."  You also get to see Tink, my daughter, dancing her reel, so that's a bonus feature.)

**UPDATE: In the time since I originally published this post, I was turned down for health insurance by a third company.  This company denied me because I had been denied by the first two companies.  We took the $6000 deductible policy for my husband and children.  At least they have some coverage.  I am now uninsured and waiting the 60 days before I can apply for the state high risk pool.  I am considering wearing a suit made of bubble wrap and a face mask until January. **

 

Megan writes at www.acorndreaming.com, a chronicle of her life and all the beautiful, crazy people who inhabit it, including her ADHD son, Ace, her old soul daughter, Tink, and her husband, IT Guy, that liar who used to wear tights. 

Xray Photo Credit: Freireke.

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